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2020

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Articles 3841 - 3870 of 4794

Full-Text Articles in Medical Specialties

Eikenella Corrodens And Streptococcus Anginosus Co-Infection Causing Skull Base Osteomyelitis And Internal Carotid Artery Lesion, K. Patel, C. Park, Z. Memon, N. Ilyas Jan 2020

Eikenella Corrodens And Streptococcus Anginosus Co-Infection Causing Skull Base Osteomyelitis And Internal Carotid Artery Lesion, K. Patel, C. Park, Z. Memon, N. Ilyas

Journal Articles

© 2020 The Author(s) A 35-year-old male presented with headaches and fevers. MRI of his head showed skull-based infection of the clivus extended to the right internal carotid artery. Blood and sinus cultures were positive for Eikenella corrodens and Streptococcus anginosus. He had intravenous antibiotics and sinus washout. The patient had full neurological recovery following this.

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Over-The-Scope Clip To The Rescue! A Novel Tool For Refractory Acute Nonvariceal Upper Gastrointestinal Hemorrhage, S. Amarnath, H. Khan, J. Philipose, J. Abergel Jan 2020

Over-The-Scope Clip To The Rescue! A Novel Tool For Refractory Acute Nonvariceal Upper Gastrointestinal Hemorrhage, S. Amarnath, H. Khan, J. Philipose, J. Abergel

Journal Articles

© 2020 © 2020 The Author(s). Published by S. Karger AG, Basel. Nonvariceal upper gastrointestinal hemorrhage (NVUGIH) is more prevalent than lower gastrointestinal hemorrhage and carries a high risk of mortality in the elderly, especially those with significant cardiovascular comorbidities. Traditional endoscopic methods, such as through-the-scope clips, electrocautery, and epinephrine injection, are frequently used to control these bleeds; however, they carry a 10% risk of rebleeding, and this itself carries a mortality risk of 36%. The larger over-the-scope clips (OTSC) that were initially used for the closure of fistulas and perforations are now gradually being implemented to manage NVUGIH. To …

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The Effect Of Chloroquine, Hydroxychloroquine And Azithromycin On The Corrected Qt Interval In Patients With Sars-Cov-2 Infection, M. Saleh, J. Gabriels, D. Chang, B. S. Kim, A. Mansoor, E. Mahmood, P. Makker, H. Ismail, B. Goldner, J. Willner, S. Beldner, R. Mitra, R. John, J. Chinitz, N. Skipitaris, S. Mountantonakis, L. M. Epstein Jan 2020

The Effect Of Chloroquine, Hydroxychloroquine And Azithromycin On The Corrected Qt Interval In Patients With Sars-Cov-2 Infection, M. Saleh, J. Gabriels, D. Chang, B. S. Kim, A. Mansoor, E. Mahmood, P. Makker, H. Ismail, B. Goldner, J. Willner, S. Beldner, R. Mitra, R. John, J. Chinitz, N. Skipitaris, S. Mountantonakis, L. M. Epstein

Journal Articles

Background - The novel SARs-CoV-2 coronavirus is responsible for the global COVID-19 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine ± azithromycin for the treatment of COVID-19. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes (TdP) and sudden cardiac death. Methods - Hospitalized patients treated with chloroquine/hydroxychloroquine ± azithromycin from March 1st through the 23rd at three hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome …

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Impact Of The Covid-19 Pandemic On Interventional Cardiology Fellowship Training In The New York Metropolitan Area: A Perspective From The United States Epicenter, T. Gupta, T. M. Nazif, T. P. Vahl, H. Ahmad, A. E. Bortnick, R. Jauhar, R. Kandov, M. Kim, A. Lee, S. Kodali, +11 Additional Authors Jan 2020

Impact Of The Covid-19 Pandemic On Interventional Cardiology Fellowship Training In The New York Metropolitan Area: A Perspective From The United States Epicenter, T. Gupta, T. M. Nazif, T. P. Vahl, H. Ahmad, A. E. Bortnick, R. Jauhar, R. Kandov, M. Kim, A. Lee, S. Kodali, +11 Additional Authors

Journal Articles

© 2020 Wiley Periodicals, Inc. Background: The healthcare burden posed by the coronavirus disease 2019 (COVID-19) pandemic in the New York Metropolitan area has necessitated the postponement of elective procedures resulting in a marked reduction in cardiac catheterization laboratory (CCL) volumes with a potential to impact interventional cardiology (IC) fellowship training. Methods: We conducted a web-based survey sent electronically to 21 Accreditation Council for Graduate Medical Education accredited IC fellowship program directors (PDs) and their respective fellows. Results: Fourteen programs (67%) responded to the survey and all acknowledged a significant decrease in CCL procedural volumes. More than half of the …

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Management Of Acute Myocardial Infarction During The Covid-19 Pandemic., E. Mahmud, H. L. Dauerman, F. G. Welt, J. C. Messenger, S. V. Rao, C. Grines, A. Mattu, R. Jauhar, P. Meraj, T. D. Henry, +3 Additional Authors Jan 2020

Management Of Acute Myocardial Infarction During The Covid-19 Pandemic., E. Mahmud, H. L. Dauerman, F. G. Welt, J. C. Messenger, S. V. Rao, C. Grines, A. Mattu, R. Jauhar, P. Meraj, T. D. Henry, +3 Additional Authors

Journal Articles

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with COVID-19. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in …

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Covid-19 Infection Unmasking Brugada Syndrome, D. Chang, M. Saleh, Y. Garcia-Bengo, E. Choi, L. Epstein, J. Willner Jan 2020

Covid-19 Infection Unmasking Brugada Syndrome, D. Chang, M. Saleh, Y. Garcia-Bengo, E. Choi, L. Epstein, J. Willner

Journal Articles

No abstract provided.

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Feasibility Of Radiofrequency Catheter Ablation In A Patient With Deep Brain Stimulators, M. Grabie, J. Gabriels, K. Xiang, C. S. Elayi, J. N. Makaryus, J. N. Catanzaro Jan 2020

Feasibility Of Radiofrequency Catheter Ablation In A Patient With Deep Brain Stimulators, M. Grabie, J. Gabriels, K. Xiang, C. S. Elayi, J. N. Makaryus, J. N. Catanzaro

Journal Articles

No abstract provided.

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Author's Reply—Is It Really Covid-19?, D. Chang, L. M. Epstein Jan 2020

Author's Reply—Is It Really Covid-19?, D. Chang, L. M. Epstein

Journal Articles

No abstract provided.

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The Covid-19 Pandemic And Acute Aortic Dissections In New York: A Matter Of Public Health., I. El-Hamamsy, D. R. Brinster, J. J. Derose, L. N. Girardi, K. Hisamoto, M. N. Imam, S. Itagaki, P. A. Kurlansky, C. Lau, H. Takayama, +3 Additional Authors Jan 2020

The Covid-19 Pandemic And Acute Aortic Dissections In New York: A Matter Of Public Health., I. El-Hamamsy, D. R. Brinster, J. J. Derose, L. N. Girardi, K. Hisamoto, M. N. Imam, S. Itagaki, P. A. Kurlansky, C. Lau, H. Takayama, +3 Additional Authors

Journal Articles

No abstract provided.

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A Comparison Of Existing Risk Prediction Models In Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation, B. Worku, M. Gaudino, D. Avgerinos, K. Ramasubbu, I. Gambardella, I. Gulkarov, S. Khin Jan 2020

A Comparison Of Existing Risk Prediction Models In Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation, B. Worku, M. Gaudino, D. Avgerinos, K. Ramasubbu, I. Gambardella, I. Gulkarov, S. Khin

Journal Articles

© 2020 The Author(s) Background: Patients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA-ECMO) require an immediate risk profile assessment in the setting of incomplete information. A number of survival prediction models for critically ill patients and patients undergoing elective cardiac surgery or institution of VA-ECMO support have been designed. We assess the ability of these models to predict outcomes in a cohort of patients undergoing institution of VA-ECMO for cardiogenic shock or cardiac arrest. Methods: Fifty-one patients undergoing institution of VA-ECMO support were retrospectively analyzed. APACHE II, SOFA, SAPS II, Encourage, SAVE, and ACEF scores were calculated. Their ability …

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Multifocal Extracranial Mycotic Aneurysms In A Patient With Endocarditis, A. M. Spring, M. A. Catalano, B. F. Farber, K. V. Krishnasastry, P. J. Yu Jan 2020

Multifocal Extracranial Mycotic Aneurysms In A Patient With Endocarditis, A. M. Spring, M. A. Catalano, B. F. Farber, K. V. Krishnasastry, P. J. Yu

Journal Articles

© 2020 This report describes the case of a 44-year-old man with Streptococcus gallolyticus (formerly S. bovis) endocarditis requiring surgical mitral valve replacement who developed multifocal extracranial mycotic aneurysms after the resolution of infection.

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Management Of Elective Aortic Valve Replacement Over The Long Term In The Era Of Covid-19, C. Basman, C. A. Kliger, L. Pirelli, S. J. Scheinerman Jan 2020

Management Of Elective Aortic Valve Replacement Over The Long Term In The Era Of Covid-19, C. Basman, C. A. Kliger, L. Pirelli, S. J. Scheinerman

Journal Articles

No abstract provided.

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Potential Impacts Of A Novel Integrated Extracorporeal-Cpr Workflow Using An Interventional Radiology And Immediate Whole-Body Computed Tomography System In The Emergency Department, K. Hayashida, T. Kinoshita, K. Yamakawa, S. J. Miyara, L. B. Becker, S. Fujimi Jan 2020

Potential Impacts Of A Novel Integrated Extracorporeal-Cpr Workflow Using An Interventional Radiology And Immediate Whole-Body Computed Tomography System In The Emergency Department, K. Hayashida, T. Kinoshita, K. Yamakawa, S. J. Miyara, L. B. Becker, S. Fujimi

Journal Articles

Extracorporeal cardiopulmonary resuscitation (ECPR) can be associated with increased survival and neurologic benefits in selected patients with out-of-hospital cardiac arrest (OHCA). However, there remains insufficient evidence to recommend the routine use of ECPR for patients with OHCA. A novel integrated trauma workflow concept that utilizes a sliding computed tomography (CT) scanner and interventional radiology (IR) system, named a hybrid emergency room system (HERS), allowing emergency therapeutic interventions and CT examination without relocating trauma patients, has recently evolved in Japan. HERS can drastically shorten the ECPR implementation time and more quickly facilitate definitive interventions than the conventional advanced cardiovascular life support …

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Mechanical, Team-Focused, Video-Reviewed Cardiopulmonary Resuscitation Improves Return Of Spontaneous Circulation After Emergency Department Implementation, D. M. Rolston, T. Li, C. Owens, G. Haddad, T. J. Palmieri, V. Blinder, J. L. Wolff, M. Cassara, Q. Zhou, L. B. Becker Jan 2020

Mechanical, Team-Focused, Video-Reviewed Cardiopulmonary Resuscitation Improves Return Of Spontaneous Circulation After Emergency Department Implementation, D. M. Rolston, T. Li, C. Owens, G. Haddad, T. J. Palmieri, V. Blinder, J. L. Wolff, M. Cassara, Q. Zhou, L. B. Becker

Journal Articles

No abstract provided.

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Idiopathic Bilateral Internal Jugular Vein Thrombosis Diagnosed By Point-Of-Care Ultrasound., V. M. Aquino-Jose, J. Johnson, T. Dulani Jan 2020

Idiopathic Bilateral Internal Jugular Vein Thrombosis Diagnosed By Point-Of-Care Ultrasound., V. M. Aquino-Jose, J. Johnson, T. Dulani

Journal Articles

Internal jugular vein (IJV) thrombosis is an unusual condition, especially when it develops bilaterally. This is a case of bilateral IJV thrombosis in a 77-year old female who presented to the emergency department with neck and arm swelling after discontinuing apixaban and undergoing an oropharyngeal procedure. The diagnosis of bilateral IJV thrombosis was made with the use of point-of-care ultrasound to evaluate bilateral jugular vein distention and bilateral upper extremity pitting edema found on her physical examination.

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A Telehealth-Delivered Pulmonary Rehabilitation Intervention In Underserved Hispanic And African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach., R. Pekmezaris, A. Kozikowski, B. Pascarelli, G. Wolf-Klein, E. Boye-Codjoe, S. Jacome, D. Madera, D. Tsang, J. Polo, N. Hajizadeh, +3 Additional Authors Jan 2020

A Telehealth-Delivered Pulmonary Rehabilitation Intervention In Underserved Hispanic And African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach., R. Pekmezaris, A. Kozikowski, B. Pascarelli, G. Wolf-Klein, E. Boye-Codjoe, S. Jacome, D. Madera, D. Tsang, J. Polo, N. Hajizadeh, +3 Additional Authors

Journal Articles

BACKGROUND:Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. OBJECTIVE:This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. METHODS:We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention …

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Prognostic Factors For Vte And Bleeding In Hospitalized Medical Patients: A Systematic Review And Meta-Analysis, A. J. Darzi, S. G. Karam, R. Charide, I. Etxeandia-Ikobaltzeta, M. Cushman, M. K. Gould, L. Mbuagbaw, F. A. Spencer, A. C. Spyropoulos, H. J. Schunemann, +9 Additional Authors Jan 2020

Prognostic Factors For Vte And Bleeding In Hospitalized Medical Patients: A Systematic Review And Meta-Analysis, A. J. Darzi, S. G. Karam, R. Charide, I. Etxeandia-Ikobaltzeta, M. Cushman, M. K. Gould, L. Mbuagbaw, F. A. Spencer, A. C. Spyropoulos, H. J. Schunemann, +9 Additional Authors

Journal Articles

No abstract provided.

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Covid-19 Presenting As Stroke, A. Avula, K. Nalleballe, N. Narula, S. Sapozhnikov, V. Dandu, S. Toom, A. Glaser, D. Elsayegh Jan 2020

Covid-19 Presenting As Stroke, A. Avula, K. Nalleballe, N. Narula, S. Sapozhnikov, V. Dandu, S. Toom, A. Glaser, D. Elsayegh

Journal Articles

© 2020 Elsevier Inc. Objective: Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. Methods: We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose …

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Arterial Thromboembolic Complications In Covid-19 In Low-Risk Patients Despite Prophylaxis, D. O. Griffin, A. Jensen, M. Khan, J. Chin, K. Chin, R. Parnell, C. Awwad, D. Patel Jan 2020

Arterial Thromboembolic Complications In Covid-19 In Low-Risk Patients Despite Prophylaxis, D. O. Griffin, A. Jensen, M. Khan, J. Chin, K. Chin, R. Parnell, C. Awwad, D. Patel

Journal Articles

No abstract provided.

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Cytokine Secretion In Breast Cancer Cells – Milliplex Assay Data, K. Chen, L. Satlof, G. Stoffels, U. Kothapalli, N. Ziluck, M. Lema, L. Poretsky, D. Avtanski Jan 2020

Cytokine Secretion In Breast Cancer Cells – Milliplex Assay Data, K. Chen, L. Satlof, G. Stoffels, U. Kothapalli, N. Ziluck, M. Lema, L. Poretsky, D. Avtanski

Journal Articles

© 2019 The Author(s) Metastatic breast cancer is the most advanced stage of breast cancer and the leading cause of breast cancer mortality. Although understanding of the cancer progression and metastasis process has improved, the bi-directional communication between the tumor cell and the tumor microenvironment is still not well understood. Breast cancer cells are highly secretory, and their secretory activity is modulated by a variety of inflammatory stimuli present in the tumor microenvironment. Here, we characterized the cytokine expression in human breast cancer cells (MDA-MB-231, MCF-7, T-47D, and BT-474) in vitro using 41 cytokine MILLIPLEX assay. Further, we compared cytokine …

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Covid-19 In Kidney Transplant Recipients, V. Nair, N. Jandovitz, J. S. Hirsch, G. Nair, M. Abate, M. Bhaskaran, E. Grodstein, I. Berlinrut, D. Hirschwerk, S. L. Cohen, K. W. Davidson, A. J. Dominello, G. A. Osorio, S. Richardson, L. W. Teperman, E. P. Molmenti Jan 2020

Covid-19 In Kidney Transplant Recipients, V. Nair, N. Jandovitz, J. S. Hirsch, G. Nair, M. Abate, M. Bhaskaran, E. Grodstein, I. Berlinrut, D. Hirschwerk, S. L. Cohen, K. W. Davidson, A. J. Dominello, G. A. Osorio, S. Richardson, L. W. Teperman, E. P. Molmenti

Journal Articles

No abstract provided.

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European Heart Rhythm Association (Ehra) International Consensus Document On How To Prevent, Diagnose, And Treat Cardiac Implantable Electronic Device Infections - Endorsed By The Heart Rhythm Society (Hrs), The Asia Pacific Heart Rhythm Society (Aphrs), The Latin American Heart Rhythm Society (Lahrs), International Society For Cardiovascular Infectious Diseases (Iscvid) And The European Society Of Clinical Microbiology And Infectious Diseases (Escmid) In Collaboration With The European Association For Cardio-Thoracic Surgery (Eacts), C. Blomström-Lundqvist, V. Traykov, P. A. Erba, H. Burri, J. C. Nielsen, M. G. Bongiorni, J. Poole, G. Boriani, L. M. Epstein, E. Mangoni, +10 Additional Authors Jan 2020

European Heart Rhythm Association (Ehra) International Consensus Document On How To Prevent, Diagnose, And Treat Cardiac Implantable Electronic Device Infections - Endorsed By The Heart Rhythm Society (Hrs), The Asia Pacific Heart Rhythm Society (Aphrs), The Latin American Heart Rhythm Society (Lahrs), International Society For Cardiovascular Infectious Diseases (Iscvid) And The European Society Of Clinical Microbiology And Infectious Diseases (Escmid) In Collaboration With The European Association For Cardio-Thoracic Surgery (Eacts), C. Blomström-Lundqvist, V. Traykov, P. A. Erba, H. Burri, J. C. Nielsen, M. G. Bongiorni, J. Poole, G. Boriani, L. M. Epstein, E. Mangoni, +10 Additional Authors

Journal Articles

© 2019 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket …

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Inpatient Use Of Ambulatory Telemetry Monitors For Covid-19 Patients Treated With Hydroxychloroquine And/Or Azithromycin, D. Chang, M. Saleh, J. Gabriels, H. Ismail, B. Goldner, J. Willner, S. Beldner, R. Mitra, R. John, L. M. Epstein Jan 2020

Inpatient Use Of Ambulatory Telemetry Monitors For Covid-19 Patients Treated With Hydroxychloroquine And/Or Azithromycin, D. Chang, M. Saleh, J. Gabriels, H. Ismail, B. Goldner, J. Willner, S. Beldner, R. Mitra, R. John, L. M. Epstein

Journal Articles

No abstract provided.

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Hrs/Ehra/Aphrs/Lahrs/Acc/Aha Worldwide Practice Update For Telehealth And Arrhythmia Monitoring During And After A Pandemic., N. Varma, N. F. Marrouche, L. Aguinaga, C. M. Albert, E. Arbelo, J. Choi, M. K. Chung, G. Conte, L. M. Epstein, P. D. Varosy, +13 Additional Authors Jan 2020

Hrs/Ehra/Aphrs/Lahrs/Acc/Aha Worldwide Practice Update For Telehealth And Arrhythmia Monitoring During And After A Pandemic., N. Varma, N. F. Marrouche, L. Aguinaga, C. M. Albert, E. Arbelo, J. Choi, M. K. Chung, G. Conte, L. M. Epstein, P. D. Varosy, +13 Additional Authors

Journal Articles

No abstract provided.

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An Algorithm For Managing Qt Prolongation In Coronavirus Disease 2019 (Covid-19) Patients Treated With Either Chloroquine Or Hydroxychloroquine In Conjunction With Azithromycin: Possible Benefits Of Intravenous Lidocaine, R. L. Mitra, S. A. Greenstein, L. M. Epstein Jan 2020

An Algorithm For Managing Qt Prolongation In Coronavirus Disease 2019 (Covid-19) Patients Treated With Either Chloroquine Or Hydroxychloroquine In Conjunction With Azithromycin: Possible Benefits Of Intravenous Lidocaine, R. L. Mitra, S. A. Greenstein, L. M. Epstein

Journal Articles

No abstract provided.

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Challenges In The Interpretation And Application Of Typical Imaging Features Of Covid-19., Mm Hammer, Ca Raptis, Ts Henry, A Shah, S Bhalla, Md Hope Jan 2020

Challenges In The Interpretation And Application Of Typical Imaging Features Of Covid-19., Mm Hammer, Ca Raptis, Ts Henry, A Shah, S Bhalla, Md Hope

Journal Articles

No abstract provided.

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Covid-19 Epidemic Peer Support And Crisis Intervention Via Social Media, P Cheng, G Xia, P Pang, B Wu, W Jiang, Y-T Li, M Wang, Q Ling, X Chang, X Bi, +3 Additional Authors Jan 2020

Covid-19 Epidemic Peer Support And Crisis Intervention Via Social Media, P Cheng, G Xia, P Pang, B Wu, W Jiang, Y-T Li, M Wang, Q Ling, X Chang, X Bi, +3 Additional Authors

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No abstract provided.

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Covid-19 In Children: More Than Meets The Eye, Sh F. Hagmann Jan 2020

Covid-19 In Children: More Than Meets The Eye, Sh F. Hagmann

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No abstract provided.

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Educating Surgeons To Educate Patients About The Covid-19 Pandemic, A Saxena, M Bullock, Jr Danoff, Ds Rodd, Sj Fischer, Bm Stronach, Br Levine Jan 2020

Educating Surgeons To Educate Patients About The Covid-19 Pandemic, A Saxena, M Bullock, Jr Danoff, Ds Rodd, Sj Fischer, Bm Stronach, Br Levine

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No abstract provided.

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Time To Intra-Arrest Therapeutic Hypothermia In Out-Of-Hospital Cardiac Arrest Patients And Its Association With Neurologic Outcome: A Propensity Matched Sub-Analysis Of The Princess Trial, A. Awad, F. S. Taccone, M. Jonsson, S. Forsberg, J. Hollenberg, A. Truhlar, M. Ringh, B. S. Abella, L. B. Becker, P. Nordberg, +2 Additional Authors Jan 2020

Time To Intra-Arrest Therapeutic Hypothermia In Out-Of-Hospital Cardiac Arrest Patients And Its Association With Neurologic Outcome: A Propensity Matched Sub-Analysis Of The Princess Trial, A. Awad, F. S. Taccone, M. Jonsson, S. Forsberg, J. Hollenberg, A. Truhlar, M. Ringh, B. S. Abella, L. B. Becker, P. Nordberg, +2 Additional Authors

Journal Articles

© 2020, The Author(s). Purpose: To study the association between early initiation of intra-arrest therapeutic hypothermia and neurologic outcome in out-of-hospital cardiac arrest. Methods: A prespecified sub-analysis of the PRINCESS trial (NCT01400373) that randomized 677 bystander-witnessed cardiac arrests to transnasal evaporative intra-arrest cooling initiated by emergency medical services or cooling started after hospital arrival. Early cooling (intervention) was defined as intra-arrest cooling initiated < 20 min from collapse (i.e., ≤ median time to cooling in PRINCESS). Propensity score matching established comparable control patients. Primary outcome was favorable neurologic outcome, Cerebral Performance Category (CPC) 1–2 at 90 days. Complete recovery (CPC 1) was among secondary outcomes. Results: In total, 300 patients were analyzed and the proportion with CPC 1–2 at 90 days was 35/150 (23.3%) in the intervention group versus 24/150 (16%) in the control group, odds ratio (OR) 1.92, 95% confidence interval (CI) 0.95–3.85, p =.07. In patients with shockable rhythm, CPC 1–2 was 29/57 (50.9%) versus 17/57 (29.8%), OR 3.25, 95%, CI 1.06–9.97, p =.04. The proportion with CPC 1 at 90 days was 31/150 (20.7%) in the intervention group and 17/150 (11.3%) in controls, OR 2.27, 95% CI 1.12–4.62, p =.02. In patients with shockable rhythms, the proportion with CPC 1 was 27/57 (47.4%) versus 12/57 (21.1%), OR 5.33, 95% CI 1.55–18.3, p =.008. Conclusions: In the whole study population, intra-arrest cooling initiated < 20 min from collapse compared to cooling initiated at hospital was not associated with improved favorable neurologic outcome. In the subgroup with shockable rhythms, early cooling was associated with improved favorable outcome and complete recovery.

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